Robert Shapiro, MD, PhD, is a Professor of Neurology at the Larner College of Medicine at UVM.

Headaches are an entirely misunderstood phenomenon. Half of Americans will experience some type of headache this year, and more than 90 percent of Americans will experience a headache in their lifetimes. While mild headaches are a nearly universal human experience, their familiarity, combined with widespread use of painkillers, has left a common impression that headaches are only a minor problem except for those with a low tolerance for pain.
This is profoundly mistaken.

In fact, a headache is often a disabling symptom that is common to many brain disorders. Chronic migraines, post-traumatic headaches, chronic daily headaches, cluster headaches and related disorders exact tremendous social, economic and personal burdens that collectively comprise a smoldering and neglected public health crisis. However, these serious disorders are caught in a blind spot of public inattention. While they are highly prevalent, costly and disabling, they are nonetheless stigmatized and dismissed.

What is a Migraine?
A migraine is actually not a headache at all. It is a recurrent episodic brain disorder that typically also includes symptoms from many other systems of the body. While a headache may be the most disabling aspect in most people, other symptoms may be equally incapacitating, including heightened or distorted sensations, cloudy thinking and so-called “autonomic” symptoms such as nausea, vomiting, nasal congestion, diarrhea, etc. For some people, migraine attacks do not even include a headache at all, yet these attacks may be just as disabling in their own ways.

Nearly one in five Americans will be afflicted with a migraine this year, resulting in more than $31 billion in economic costs and untold suffering. A World Health Organization study found that migraines are responsible for more lost years of healthy life in the United States annually than epilepsy, multiple sclerosis, ovarian cancer and tuberculosis combined.

Who is Especially at Risk for Migraines?
While the likelihood of experiencing a migraine is strongly influenced by genetic factors, it is also true that anyone could probably experience it if certain conditions were aligned. For example, women’s hormonal changes and head trauma can each increase the risk for migraine. Seventy-five percent of Americans with migraines are women. Mild traumatic brain injury or concussion is often associated with recurrent headache or migraine; approximately 60 percent of our service personnel returning from the Iraq and Afghanistan wars with such injuries suffer from headaches.

Treating Migraines

The effective treatment of migraine attacks often requires multiple approaches and may include:

  • Changes in lifestyle
  • Adding medications, when appropriate
  • Applying behavioral or physical therapies

Unfortunately, the medications that are currently available to treat a migraine are inadequate for many people who suffer from resistant attacks. Over the past 50 years, only one novel drug, sumatriptan, has been developed specifically for the acute treatment of migraines and subsequently approved following an FDA priority review. The pace of new drug discovery for migraines has been held back by historically low levels of federal research on this disorder. We are working to change this situation.

The Alliance for Headache Disorders Advocacy, a national organization based here in Vermont, is working to educate Congress about the impact of migraine and other headache disorders to prioritize federal research in this area.

Robert Shapiro, MD, PhD is a Professor of Neurology at the Larner College of Medicine at UVM.

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